Abstract: Certain exemplary embodiments can comprise a method that can comprise, for a predetermined user, automatically determining a score for each resource from a plurality of predetermined resources based on the user's weighting of predetermined factors associated with the resources and an objective score for each factor for each resource, ranking the scored resources, and/or providing an identity of a best matched resource for the user.

Abstract: A system and method for managing insurance claim denials. The system and method reviews a denial of claim from an insurer and a patient medical record received from a healthcare provider to determine if an appeal should be filed for the denial. It prepares an appeal to the denial comprising an appeals overturn letter and supporting document and submits the appeal to the insurer if it determines that an appeal should be filed. The system then tracks and monitors the progress of the appeal and process the appeal determination received from the insurer. The system utilizes these tracking and monitoring information to streamline and improve the insurance claim process of the healthcare provider, such as developing and implementing claim denial reduction program.

Abstract: An automated system is disclosed for managing accounts receivable for outstanding healthcare accounts. In particular, the system in accordance with the present invention is an automated system which preemptively assesses the risk of denials of outstanding healthcare accounts by way of a self-learning engine driven by current data and prioritizes those accounts for follow up according to the risk profile of the account. As such, the system is able to minimize denials by the respective payers thereby improving optimizing the efforts of healthcare accounts receivable personnel while improving the revenue yield and minimizing the revenue cycle.

Abstract: Systems and methods are provided for generating edits for healthcare transactions to address billing discrepancies. Information associated with an audit performed on a healthcare transaction may be received. Based at least in part on the received information, a billing discrepancy associated with the healthcare transaction may be identified. Based upon the identified billing discrepancy, a proposed edit may be generated that can be utilized to mitigate an impact of the identified billing discrepancy during the processing of one or more subsequent healthcare transactions.

Abstract: The present invention is directed to a system and method for providing care to a patient, comprising a patient care device having a number of configuration databases stored in a memory in the device. Each configuration database preferably includes protocols, operating limits, rule sets and/or operating features that collectively define an operating environment, or personality, of the device. Selection of a specific configuration database preferably is based at least in part upon patient-specific information obtained from any location in a distributed hospital network. Examples of such patient-specific information include patient age or size, patient medical characteristics, a location of the patient or a location of the care device. In a preferred embodiment, programming a patient care device to deliver a drug to a patient entails activating a configuration database and scanning a machine-readable drug label identifying a particular protocol stored in the activated database.

Abstract: The present invention relates to a method of diagnosing/predicting a degenerative disease in the hip of a subject. The method including the steps of applying a compressive force on at least one hip joint of the subject and calculating a compression index value for at least one hip joint, wherein a non-zero compression index value for the at least one hip joint is indicative of the subject developing/having a degenerative disease. The present invention also relates to a diagnostic test for determining incongruity in a hip joint of a subject, where the test includes the steps of applying a compressive force on at least one hip joint of the subject and calculating a compression index value, wherein a non-zero compression index value for the hip joint is indicative of at least mild hip joint incongruity.

Abstract: Systems and methods for managing a prescription rewards program include receiving, at a switch, an adjudicated prescription claim transaction, where the adjudicated prescription claim transaction includes an indication that the prescription claim transaction has been approved by a claim processor. The systems and methods further include identifying, from the adjudicated prescription claim transaction, a patient associated with the adjudicated prescription claim transaction, retrieving, from a database associated with the switch, a reward accumulator value associated with the patient, and updating the reward accumulator value associated with the patient based at least in part on the adjudicated prescription claim transaction. The systems and methods may further include determining that a threshold value has been satisfied by the reward accumulator value, and issuing a reward message based at least in part on the reward accumulator satisfying the threshold value.

Abstract: An online system and method enabling users to exchange information and establish collaboration in scientific projects on rare diseases is described. The website allows users to create a list of symptoms for a patient with a rare disease who is under their care. The patient's list of symptoms is then used to find other patients sharing a similar list of symptoms. A matching system creates a match report that ranks patients with similar symptoms. Once a list of potential matches is available, the user may take the initiative of contacting other colleagues with similar clinical cases under their care, for the purpose of exchanging information and/or establishing collaboration in scientific projects about a particular rare disease. A database containing information on rare diseases, along with other services, is also provided to the users at the website.

Abstract: A computer system includes a data storage device. The data storage module receives, stores, and provides access to historical claim data. A categorical aggregation component comprising program instructions stored in a program memory provides categorized and aggregated historical claim data by identifying claim categories based on the historical claim data, each of the one or more claim categories associated with a respective set of claim characteristics, identifying claims of the historical claim data associated with one of the claim categories, assigning each identified claim to one of a plurality of total severity ranges based on the total severity of the identified claim, and determining an average cost per claim year for claims of each total severity range when executed by a computer processor.

Abstract: A system for facilitating the provision of health care services to patients comprises a computer-readable medium containing information associated with the provision of health care services to patients; an electronic display disposed in a health care environment; and software configured to effect display of some of the information on the electronic display. A method for facilitating the provision of health care services to patients comprises inputting, via an electronic touch screen display, information corresponding to a patient or room; displaying, via the electronic touch screen display, the information; and providing, to a patient, physical health care services, based on the viewed information. The electronic touchscreen display preferably is not a part of a computer workstation and is configured for simultaneous viewing by a plurality of health care providers and caregivers.

Abstract: Some embodiments provide a system for synchronizing and configuring monitoring devices. In some embodiments, a patient monitoring device settings module is configured to automatically provide configuration settings to a plurality of patient monitoring devices. A monitoring device data module is configured to receive measurement data from at least one of the patient monitoring devices. An electronic medical records system interface is configured to provide patient data at least partially derived from the received measurement data to an electronic medical records system. A patient records interface is configured to provide patient data to at least one of the patient monitoring devices.

Abstract: An information management system for restricting access to personal data in compliance with law or regulation includes a database having restricted records stored therein, at least one of the records including an identification of a client or group of clients about whom said record concerns. A computer system under the control of a trusted information broker is configured to receive via a communication medium a request initiated by a requestor for access to at least one of the restricted records in the database, the request including an identification of the requestor. The computer system is further configured to transmit a request for consent to the client and receive an indication from the client that the client consents or does not consent to access to the restricted record by the requestor. The computer system grants or denies access to the restricted records based upon the indication from the client.

Abstract: A method for receiving prescription data from a pharmacy is provided. The method includes emulating a device, such as using a pseudo TTY feature of a Unix operating system or a pseudo device of a Windows operating system. A prescription authorization system is then set to transmit data to the emulated device when the prescription data is provided to a claims approval agency by the prescription authorization system. The data can be supplemented with data from a secondary source, such as a system that acquires data in accordance with the Health Insurance Portability and Accountability Act or other suitable systems. The prescription data and any supplemental data is then received at the prescription authorization system, and is transmitted to the emulated device. The prescription data is also stored in a local log file, and is transmitted to a data warehouse over a network using the emulated device.

Abstract: A system and method for generating a medical history that is determined based on the patient's medication list. Medications are taken for specific indications, i.e., disease and/or symptom, and the system includes a knowledge base of all known medications and associated indications. Preferably, an expert system allows the patient, nurse or other user, to enter all or part of the name of the patient's medications, and creates a list of probable medications by determining which of the known medications the patient most likely takes. Based on a user selected probable medication, the system creates a list of probable medical indications associated with the selected medication. Based on a user selected probable indication, the system generates a medical history for the patient. The probable medications and probable medical indications are determined preferably based on the patient's demographic data, historical data for other patients, and responses to follow-up questions generated by the system.

Abstract: In one aspect, the invention comprises a computer implemented method comprising: (a) determining an average monthly cost of long term care for a consumer; (b) determining an estimated total cost of long term care for the consumer; (c) receiving and storing in a computer readable medium data describing the consumer's preferences regarding long term care resources; (d) calculating with a processor an initial benefit amount for the consumer; (e) adjusting with a processor the initial benefit amount based on the data describing the consumer's preferences to determine a total benefit amount; and (f) recommending a long term care policy providing the total benefit amount to the consumer, wherein the processors may the same processor or different processors. Other aspects of the invention comprise related method, computer system, and software embodiments.

Abstract: The medical safety box is a system using RFID (Radio Frequency Identification) technology to ensure that correct delivery of the correct treatment in the form of medication or injection to in-hospital patients is consistently carried out. The system includes a medical box containing whatever medication or injection that needs to be administered to a specific patient. The box has a locking mechanism that can only be opened by an RFID wristband, which is worn by that same specific patient, thus assuring that the medicine in the box is administered to the correct patient.

Abstract: The present invention is directed to a system and method which allows a prospective insured to make an informed decision on healthcare insurance or a specific health care management decision by using a current medical profile to assist in their selection. Based on past medical care, as obtained from payor data, a number of different plans, each having different providers, different deductibles, different maximums, different reimbursement policies, etc., a person can make an informed decision. When a family has different payors for different family members, a proper blend of payors can be more easily selected since the payors (or a single payor) has a medical profile of each family member and also has information on providers in the network, prescription policies, deductibles, maximums, etc.

Abstract: Computer-implemented methods and systems for connecting and facilitating communication among healthcare volunteers, organizations, patients and donors are disclosed. A matching system to match volunteers, donors, organizations and patients to coordinate and manage providing low cost or free health care services is disclosed. An donation inventory management system is also disclosed. Dynamic volunteer coordination methods for responding to public health events are also disclosed.

Abstract: Electronic to-do lists are provided in a computerized healthcare environment for managing and documenting events during clinical care processes. A to-do list includes events that may need to be completed and, in some cases, documented during a clinical care process. The to-do list may be generated in response to a selection of a to-do macro including data associated with a number of clinical events that need to be completed during the clinical care process. As events are completed by clinicians during the process, the to-do list may be used to document the completion of the event. As such, clinicians may readily identify events that have been performed, as well as events that have yet to be performed. In some cases, a clinical event in a to-do list may include associated details, which may be used to populate information in an electronic record when the clinical event is indicated as completed.

Abstract: A system and method for managing insurance claim denials. The system and method reviews a denial of claim from an insurer and a patient medical record received from a healthcare provider to determine if an appeal should be filed for the denial. It prepares an appeal to the denial comprising an appeals overturn letter and supporting document and submits the appeal to the insurer if it determines that an appeal should be filed. The system then tracks and monitors the progress of the appeal and process the appeal determination received from the insurer. The system utilizes these tracking and monitoring information to streamline and improve the insurance claim process of the healthcare provider, such as developing and implementing claim denial reduction program.